The first of the month of July marks the first visible sign of the recently passed Health Care Reform Act. You might not notice it unless you are paying to get a tan. The 10% tax on tanning salons has gone into effect and it will cost you that much more to get one now. Tanning salons were easy targets for Washington legislators. With analogies to tobacco and alcohol, its association with increased skin cancer risks made it easy pickings with no significant protest. The initial cosmetic target was a Botox tax but that ran aground due to being a gender-biased tax. The elephant sitting in the room with the tanning salon tax is that it is a racially-biased tax…but I digress.
The debate over the Health Care Reform Act is all but a faint rumble now but it was really a largely economic and taxing exercise over an issue that has long been decided. With Medicare and Medicaid now making up well over half of whom most doctors and hospitals service, and with the percent growing, we have insidiously grown into a nationalized health service that existed before this recent discussion. Throw in the large Veteran’s Administration and military service health facilities and the government is by far the biggest payor for our nation’s health. The recent legislation was merely the tipping point that made the path to greater government control over heath care just go faster and even more evident.
While many clamored that the health system in the U.S. was broken, the reality is that it functions pretty well but is overwhelmed with demand that exceeds the economics to pay for it. The idea of insurance coverage and a societal safety net established in the 1960s never could have envisioned the population demand and the magnitude of health care advancements that have occurred in the past forty years. The very feature that makes our health care system the best in the world…a system driven by entrepeneurship…is exactly what is making it suffocatingly affordable to many individuals and businesses now.
The one certainty that will result from this legislation is that you will be paying more…and eventually getting less. No matter how it was painted and sold in Washington, this is an absolute certainty. As a result, we have been seeing for the past few years the development of the field of concierge medicine. As a fee for service concept, you pay a flat fee per year for an individual or family and get access to medical care 24-7. Various tests that may be needed are still billed to your insurance company. This allows you to use your health insurance as a catastrophic plan (and even a one day stay in the hospital can be an economic catastrophe) and pay lower premiums. This may only lower your out-of-pocket a little but it changes the level of service and cuts down on the amount of paperwork needed for doctor visits, etc.
While concierge medicine may not be the right choice for everyone, it is taken out of the playbook that plastic surgeons have used for decades. Elective cosmetic surgery, such as breast augmentation, facelifts and tummy tucks, is the original form of the concierge medicine fee-for-service concept. The idea of paying a fixed price for a certain medical service is re-emerging and will become increasingly popular. As more doctors withdraw from Medicare and Medicaid, due to the abysmal reimbursements and the labryinth of befuddlling paperwork and coding schemes, cash providers and practices will again become more commonplace.
Dr. Barry Eppley